Cochrane Gynaecology and Fertility vs COVID-19: Collaborating to produce the ‘PregCov-19’ living systematic review
COVID-19 is especially dangerous for at risk populations, such as pregnant women. It is critical to determine how COVID-19 affects pregnant women and their babies. A regular systematic review methodology is not sufficient to synthesise the overwhelming amount of evidence produced daily worldwide. Cochrane Gynaecology and Fertility needed to carry out a living systematic review, meaning the review would be continually updated, incorporating new studies as they become available.
The ‘PregCov-19’ living systematic review project commenced at the beginning of April 2020, and latest results from the living systematic review were published in September 2020. Cochrane Gynaecology and Fertility created a webpage on the University of Birmingham website to highlight the project and make it easily accessible to pregnant women, researchers, and clinicians worldwide.
Learn more about this work and what Cochrane Gynaecology and Fertility learned in the process by reading this short case story.
Cochrane is delighted to launch Spanish and Japanese translations of MECIR (Methodological Expectations for Cochrane Intervention Reviews) from Cochrane Iberoamerica and Cochrane Japan, respectively.
These are the first translations of Cochrane’s methods guidance since the launch of version 6 of the Cochrane Handbook for Systematic Reviews of Interventions (see this Cochrane Editorial for more details about the Handbook’s launch). This is an important milestone in supporting the engagement of people with different native languages in Cochrane Reviews.
Ensuring that Cochrane Reviews represent the highest possible quality is critical if they are to inform decision making in clinical practice and health policy. MECIR are Standards that guide the conduct and reporting of Cochrane Intervention Reviews; they are essential the ‘how-to’ guide for Cochrane Reviews and are drawn from the Cochrane Handbook for Systematic Reviews of Interventions. All Standards are tagged as ‘mandatory’ or ‘highly desirable’. Mandatory Standards should always be met unless an appropriate justification for not doing so can be provided. Highly desirable Standards should generally be implemented but justification for not implementing them is unnecessary.
The development of MECIR has been a collaborative effort over the years, involving review authors, editors and methodologists from all corners of our community. We are thrilled that this collaboration now includes Cochrane Translation Teams.
Dr Karla Soares-Weiser, Cochrane’s Editor-in-Chief, said: “Cochrane has published more than 33,900 translations of Cochrane Review plain language summaries and/or abstracts as of December 2020. Even though Cochrane Reviews are produced in English, having methods guidance for our Reviews available in non-English languages can help increase the diversity and inclusivity of author teams, especially for Reviews that need expertise from particular settings or countries where English is not a native language. The translation of Cochrane methods guidance is also important for review and methods training in non-English speaking countries as it reduces the linguistic barrier for researchers getting involved.”
Dr Xavier Bonfill Cosp, Director of Cochrane Iberoamerica, said: “The Spanish version of MECIR is a useful tool for Spanish-speaking authors and will contribute that high-quality reviews are conducted in the global multilingual collaboration that is Cochrane. At Cochrane Iberoamerica we are happy to have been part of this translation effort and we look forward to increasing its accessibility in the future through more interactive on-line platforms.”
Dr Norio Watanabe, Director of Cochrane Japan, said: “I am very happy and honored to publish the Japanese version of the MECIR, because I believe this can contribute not only to Cochrane review authors but also to anyone who thinks of interpreting results from systematic reviews in Japan. We are now planning to translate the latest version of Cochrane Handbook for Systematic Reviews of Interventions as a next step.”
Post written by Judith Deppe (Multi-language Programme Manager, Cochrane) and Ella Flemyng (Methods Implementation Manager, Cochrane)
Cochrane statement to the 148th WHO Executive Board meeting on strengthening global emergency preparedness
The World Health Organization (WHO) Executive Board is meeting virtually this week (18-26 January).
The Executive Board, which is made up of 34 elected members from WHO Member States, is responsible for implementing the decisions and policies of the World Health Assembly (WHO’s decision-making body) and to advise and facilitate WHO’s work.
Our statement highlights the ongoing contributions of the Cochrane community to the international COVID-19 response, and pledges support for WHO’s efforts in preparing for future health emergencies.
The full statement is below:
The COVID-19 pandemic has clearly demonstrated the critical importance of timely evidence-informed global health policy. Governments, healthcare professionals and researchers worldwide continue to seek answers to questions related to the treatment of patients, and how best to protect populations.
Cochrane is a global leader in the production of high-quality synthesized evidence to inform health decision making. Over the last year, we have worked closely with WHO by producing rapid reviews to answer its priority questions related to COVID-19. We published 25 reviews on priority questions related to clinical management of patients with COVID-19 and public health measures to prevent transmission of disease; these reviews are being regularly updated as new evidence becomes available. To help make sense of the large volume of research being published every day, we also launched and are maintaining one of the largest and most sophisticated registries of COVID-19 studies a living synthesis of COVID-19 study results and Cochrane Groups around the world are working within their settings to provide evidence for decision making.
While many countries are currently experiencing the highest number of COVID-19 cases since the pandemic began, vaccines are starting to become available – giving the world hope for the future. As we begin to look ahead to beyond COVID-19, we should really learn from this pandemic and think about what preparedness for future health emergencies should involve, which surveillance systems are needed and what the research community can do to support WHO and Member States in preparing for this.
Cochrane is therefore committed to not only support WHO with its norms, standards and guidelines work with evidence synthesis throughout the remainder of the COVID-19 pandemic, but also to contribute towards ensuring global preparedness for future pandemics and health emergencies.
- The 148th session of the Executive Board take place on 18-26 January 2021. You will be able follow proceedings on this webcast
Embrace your geek chic and love for evidence-based healthcare with Cochrane merch!
Over the years, branded items have been printed out to celebrate Colloquia and special events and milestones. Many take pride in wearing and using something branded with the global organization they are a part of or use - and it was time for a refresh!
The Cochrane Store brings designs that celebrate evidence-based healthcare, take pride in the rigger and quality of systematic reviews, and show the world you are a supporter of high-quality Cochrane evidence! All money from sales are reinvested in helping people get involved in Cochrane.
The initial designs added to the store were created by science illustrator Science Scribbles. Dr. Lauren Callender says, "For this project, I particularly wanted to draw attention to the fact that Cochrane is very highly regarded by the scientific community. I hope I was able to visually depict this and that people will really love the designs!"
If you're looking for something with just the logo or an item with a bit of humour, we have mugs, t-shirts and totes that cover that! These are great for those that want to share their pride in using Cochrane reviews or their involvement in creating them.
We love seeing your Cochrane items 'out in the wild'! Share your photos using the hashtag #MyCochrane and to be sure we see them and give you credit email your picture to email@example.com and let us know your Instagram or Twitter handle so we can give you credit!
Wednesday, February 3, 2021
Stopping smoking brings enormous health benefits, but can be very challenging.
In this talk, Cochrane author and editor Dr Jamie Hartmann-Boyce talks through Cochrane evidence on the best and most common ways to quit smoking.
This talk is based off an article in The Conversation co-authored by Jamie and Dr Nicola Lindson, Cochrane author and managing editor of the Cochrane Tobacco Addiction Group. The talk was hosted by Oxford at Home, the University of Oxford’s weekly programme of live knowledge sharing online ‘tutorials.’
In March 2020, in direct response to the COVID-19 pandemic, Cochrane Ireland, Evidence Synthesis Ireland and the HRB-Trials Methodology Research Network (HRB-TMRN), worked with partners to set up the Emergency Evidence Response Service at NUI Galway. As part of this initiative, they created iHealthFacts, an online resource where members of the public can check the current evidence for health claims.
iHealthFacts helps the public to use evidence to make informed decisions about their own health while also providing a platform where members of the public can submit health claim questions to be ‘fact checked’ by a team of evidence researchers.
Learn more about iHealthFacts, including the success of this initiative and what this collaborative team has learnt in the process, in this short case story.
The past year has shown how important good quality evidence is. Here at Cochrane, we create short simple summaries of our reviews called Plain Language Summaries. These summaries are meant to be accessible by people around the world, so they can use them to make health care decisions. We would like your opinion on how to make these summaries easier to understand.
We are looking for volunteers to read two summaries and tell us if they are easy to understand. We are seeking feedback from everyone, especially members of the public, healthcare professionals, journalists and people who influence policy. Please feel free to share this message with anyone who might help.
No experience is needed. We will email you a short document and ask you to send us your feedback within two weeks. It will take 30-45 minutes.
The world needs good evidence now more than ever before. With your help we can make evidence more understandable, helping people make informed decisions for better health.
To take part, click here to submit your email by 23 February 2021.
Thursday, January 21, 2021
The Cochrane Neuromuscular Group is looking to appoint one or more new Co-ordinating Editor(s) to provide leadership of the Group. The Cochrane Neuromuscular Group is part of the Cochrane Mental Health and Neuroscience Network. This is an important opportunity to lead and shape the future development of a strategically important area of Cochrane’s healthcare evidence coverage. The Neuromuscular Group’s portfolio of reviews includes 57 active reviews and 22 protocols.
Applications are welcomed from individuals based in any country. We invite applications from within existing Cochrane Groups and beyond, and also individuals interested in a job share. Applicants should be aware of the following requirements:
1. The Co-ordinating Editor(s) must have:
- Experience of authoring Cochrane or alternative high quality systematic reviews
- Clinical expertise and standing in the field of neuromuscular diseases.
- Methodology expertise in the field of evidence synthesis, including risk of bias and GRADE assessments
2. The following attributes are highly desirable
- Experience of editing Cochrane reviews or alternative high quality systematic reviews
- Advanced methodological skills and knowledge
3. The new Co-ordinating Editor(s) must work within the terms of the Collaboration Agreement that defines the responsibilities of Cochrane and the Cochrane Review Group.
4. The new Co-ordinating Editor(s) must actively engage with the Cochrane Mental Health and Neuroscience Network and adhere to the Network’s strategic plan.
Potential applicants should familiarise themselves with Cochrane’s commercial sponsorship and conflict of interest policy.
Individuals who are interested to explore this opportunity are welcome to speak with Robert Boyle (firstname.lastname@example.org), Rosaline Quinlivan (email@example.com) or Michael Lunn (MichaelLunn@nhs.net).
- To apply, please send a cover letter which includes a summary of your experience and skills in relation to the bullet points above, and a Curriculum Vitae to Robert Boyle (firstname.lastname@example.org)
- For further information, please review the full role description.
- Deadline for applications: Monday 1st February 2021 (12 midnight GMT)
- Details of interviews will be provided in the due course
Skin care treatments in babies, such as using moisturisers on the skin during the first year of life, probably do not stop them from developing eczema, and probably increase the chance of skin infection.
The authors are uncertain how skin care treatments might affect the chances of developing a food allergy. We need evidence from well-conducted studies to determine effects of skin care on food allergies in babies.
What are allergies?
An immune response is how the body recognises and defends itself against substances that appear harmful. An allergy is a reaction of the body's immune system to a particular food or substance (an allergen) that is usually harmless. Different allergies affect different parts of the body, and their effects can be mild or serious.
Food allergies and eczema
Eczema is a common skin allergy that causes dry, itchy, cracked skin. Eczema is common in children, often developing before their first birthday. It is sometimes a long-lasting condition, but it may improve or clear as a child gets older.
Allergies to food can cause itching in the mouth, a raised itchy red rash, swelling of the face, stomach symptoms or difficulty breathing. They usually happen within 2 hours after a food is eaten.
People with food allergies often have other allergic conditions, such as asthma, hay fever, and eczema.
As review authors we wanted to learn how skin care affects the risk of a baby developing eczema or food allergies. Skin care treatments included:
- putting moisturisers on a baby's skin;
- bathing babies with water containing moisturisers or moisturising oils;
- advising parents to use less soap, or to bathe their child less often; and
- using water softeners.
We also wanted to know if these skin care treatments cause any unwanted effects.
What did we do?
The authors searched for studies of different types of skin care for healthy babies (aged up to one year) with no previous food allergy, eczema, or other skin condition.
Search date: we included evidence published up to 23 July 2020.
They were interested in studies that reported:
- how many children developed eczema, or food allergy, by age one to three years;
- how severe the eczema was (assessed by a researcher and by parents);
- how long it took for eczema to develop;
- parents' reports of immediate (under two hours) reactions to a food allergen;
- how many children developed sensitivity to a particular food allergen; and
- any unwanted effects.
The authors assessed the strengths and weaknesses of each study to determine how reliable the results might be. They then combined the results of all relevant studies and looked at overall effects.
Author Dr Maeve Kelleher, Honorary Clinical Senior Lecturer in Paediatric Allergy, Imperial College London explains, “Lots of babies get eczema, which can be very itchy and irritating for them. Babies with eczema are also more likely to have food allergy, hayfever or asthma. This project put together many studies conducted around the world, assessing if eczema could be prevented by putting moisturiser on babies skin from the first few days after they are born. Prior to this project, some studies have reported you could prevent eczema with daily application of a moisturiser. We looked at the results of over 3000 infants, from seven studies, and we can now say that daily moisturising of a babies skin cannot prevent a baby developing eczema and can even cause some increased skin infections.
There is strong link between eczema and food allergy, but unfortunately there were not enough babies in this study to tell us whether putting on a daily moisturisers changes the risk of food allergy."
The authors found 33 studies involving 25,827 babies. These studies took place in Europe, Australia, Japan, and the USA, most often at children's hospitals. Skin care was compared against no skin care or care as usual (standard care). Treatment and follow-up times ranged from 24 hours to two years. Many studies (13) tested the use of moisturisers; others mainly tested the use of bathing and cleansing products and how often they were used.
The authors then combined the results of 11 studies; eight included babies thought to have high risk of developing eczema or a food allergy.
The review authors are moderately confident in the results for developing eczema and the time needed to develop eczema. These results might change if more evidence becomes available. They are less confident about the results for food allergy or sensitivity, which are based on small numbers of studies with widely varied results. These results are likely to change when more evidence is available. Our confidence in our findings for skin infections is moderate but is low for stinging or allergic reactions and slipping.
Why is this review important?
Self‐harm (SH), which includes intentional self‐poisoning/overdose and self‐injury, is a major problem in many countries and is strongly linked with suicide. It is therefore important that effective treatments for SH patients are developed. Whilst there has been an increase in the use of psychosocial interventions for SH in adults (which is the focus of a separate review), drug treatments are frequently used in clinical practice. It is therefore important to assess the evidence for their effectiveness.
Who will be interested in this review?
Hospital administrators (e.g. service providers), health policy officers and third party payers (e.g. health insurers), clinicians working with patients who engage in SH, patients themselves, and their relatives.
What questions does this review aim to answer?
This review is an update of a previous Cochrane Review from 2015 which found little evidence of beneficial effects of drug treatments on repetition of SH. This update aims to further evaluate the evidence for effectiveness of drugs and natural products for patients who engage in SH with a broader range of outcomes.
Which studies were included in the review?
To be included in the review, studies had to be randomised controlled trials of drug treatments for adults who had recently engaged in SH.
What does the evidence from the review tell us?
There is currently no clear evidence for the effectiveness of antidepressants, antipsychotics, mood stabilisers, or natural products in preventing repetition of SH.
What should happen next?
We recommend further trials of drugs for SH patients, possibly in combination with psychological treatment.
During the COVID-19 pandemic, people relied on research evidence to help make decisions that affected the health of millions. Cochrane had the skills and experience to draw together the research evidence. We needed to work more quickly than our usual systematic review process, which sometimes takes many months to search widely and assess research. Cochrane Methods Rapid Reviews group developed a way to create rapid reviews, which streamlined our processes to create high-quality reviews very quickly.
In March 2020, the Cochrane Methods Rapid Reviews group launched guidance about how to undertake a rapid review. This group will continue to develop guidance as we learn more about the most efficient and useful approaches. They also introduced new systems to produce rapid reviews about COVID-19 quickly and provided advice and training to teams conducting rapid reviews, living evidence mapping and living systematic reviews.
At the start of the COVID-19 pandemic, many countries implemented lockdowns or stay-at-home orders. Most dental services provided only emergency treatment so patients and dental professionals could stay safe. This left many people in pain or without access to care. As countries began to ease their lockdown restrictions, policy-makers and dental professionals wanted to know when and how best to reopen dental services. Cochrane Oral Health aimed to help them make decisions informed by evidence.
Cochrane Oral Health compiled research and international guidance about COVID-19 and dental services. They developed a webpage summarising relevant guidance documents for dental care. They targeted their materials to policy-makers who needed to make decisions about how dental practices could reopen.
'Let's talk e-cigarettes'' is a podcast talking about the latest research on e-cigarettes and how new research changes what we know about them. It's hosted by Cochrane Tobacco Addiction researchers Dr Jamie Hartmann-Boyce and Dr Nicola Lindson based at the University of Oxford, through funding from Cancer Research UK. You can listen to the podcast on iTunes, Spotify, or below.
In this initial podcast, they discuss evidence from a Cochrane Living Review of e-cigarettes for smoking cessation, what they found in a recent search, and a deep-dive into one recent study with Professor Mark Eisenberg. Transcript of podcast
Decision-makers are making decisions about COVID-19 that affect the health of millions of people. Researchers have been quick to do studies about COVID-19, but it can be difficult to stay up to date. Cochrane France wanted to bring together the global evidence about preventing, treating and rehabilitating people with COVID-19 regularly and in one place, so they collaborated on the COVID-NMA initiative.
The COVID-NMA initiative has three overarching parts:
- Mapping randomized controlled trials about the effectiveness of interventions for preventing and treating COVID-19 and assessing vaccines.
- Living evidence syntheses of the effectiveness of treatments for COVID-19.
- Recording data about the quality and transparency of the study designs.
In April 2020, the Chilean Satellite of Cochrane EPOC contacted the Department of Health Technology Assessment and Evidence Based Health in the Chilean Ministry of Health (HTA). They knew that the Ministry was likely to need evidence-based responses to the COVID-19 pandemic. The Review Group staff suggested that they could help to summarise the existing evidence so it could support the Ministry of Health at a time when rapid decision making was needed.
As of December 2020, the Chilean Satellite of Cochrane EPOC had produced 4 SUPPORT summaries supporting the Chilean Ministry of Health’s questions on COVID-19, with another 10 in progress.
They have presented the summaries directly to over 30 policy makers at the Ministry, including the regional Heads of Department. Feedback from the Ministry was that they were grateful for this work and that it was presented in a way that could be used in decision making.
To learn more about this work about how Cochrane has worked with policy makers, read this short case story.
Many experts published their opinions about the impact of COVID-19 on rehabilitation early on, but none were based on real-world experience. Cochrane Rehabilitation wanted to share information rapidly as it emerged so rehabilitation services and patients around the world would know how the pandemic might affect them.
Since March 2020, Cochrane Rehabilitation have been compiling the best evidence available into a living rapid systematic review. They worked with the World Health Organization Rehabilitation Programme to identify the highest research priorities, and jointly defined the topics for which to search the best available evidence about the impact of COVID-19. These were also used to develop a Cochrane Library Special Collection.
They also developed an online interactive living evidence map which synthesises research relevant to the needs and priorities and provides an interactive access to the current results.
Learn more about the impact of this work by Cochrane Rehabilitation by reading short case story.
There were no prevention or treatment protocols in place when COVID-19 reached South Africa. Policy-makers needed to work rapidly to support our diverse communities. There were thousands of studies emerging from around the world, but there was a lot of duplication, variable quality and sometimes contradictory findings. The South African (SA) GRADE Network, co-lead by Cochrane South Africa and the Centre for Evidence-based Health Care, wanted to help policy-makers make decisions based on the best available research evidence in a timely way.
The SA GRADE Network worked with a sub-committee of the National Essential Medicines List Committee (NEMLC) from the South African National Department of Health. The sub-committee prioritised research questions. The SA GRADE Network worked with them to complete rapid reviews to answer these questions within 7-10 days.
Members of the SA GRADE Network worked on these rapid reviews with members of the Government sub-committee. This novel approach meant that they could work collaboratively and build relationships, ensuring that the reviews met policy-makers’ needs.
Behavioural support can help more people to stop smoking for six months or longer, without causing unwanted effects.
Some types of support appear to work better than others. More studies are needed to identify the best ways to support people who are trying to stop smoking, and to identify the best people to support them.
The best thing people who smoke can do for their health is to stop smoking. People breathe more easily and cough less when they stop smoking. Stopping also lowers their risk of getting lung cancer and other diseases.
How to help people stop smoking
Most people who smoke want to stop, but many find it difficult. People who smoke may use nicotine replacement therapy, such as nicotine patches or gum, or other medicines to help them stop. Behavioural support provides an alternative – or additional – way to help people stop smoking. Sometimes behavioural support can be combined with nicotine replacement or other medicines to help people stop smoking.
Types of behavioural support can include: advice and counselling on ways to make it easier to stop smoking; information about why or how to stop; or a combination. Behavioural support can be given in group sessions or one-to-one.
Why did the authors do this Cochrane Review?
The authors wanted to find out:
- which types of behavioural support work best to help people stop smoking;
- the best ways to give behavioural support (including the best people to give it); and
- what aspects of behavioural support help someone to stop smoking.
They also wanted to know if behavioural support can cause any unwanted effects.
What did authors do?
They searched for Cochrane Reviews of behavioural support to stop smoking, to identify relevant studies of adults who smoked. They then compared the studies with each other, to find out how well the different types of behavioural support helped people to stop smoking.
Search date: the authors included evidence published up to July 2020.
What they found
The authors found 33 Cochrane Reviews, from which they identified 312 relevant studies in 250,503 adults (aged 18 to 63 years) who smoked cigarettes. The studies investigated 437 different combinations of ways to stop smoking.
The studies looked at the following types of behavioural support, among others:
- giving someone information about their test results, or their risk of smoking-related disease;
- counselling (face-to-face, by telephone or by video call);
- self-help materials, resources, and reminders by mobile phone messages or apps;
- rewards (money, or a chance to win money by entering competitions);
- exercise-based support; and
In the studies, a variety of people provided behavioural support, including: doctors, consultants, nurses, pharmacists, dentists, counsellors and lay health advisors.
Most studies were conducted in the USA or Western Europe; 115 studies took place in healthcare settings and 195 took place in the community. On average, people taking part in the studies were followed up for 10.5 months.
The studies compared the effects of behavioural support with:
- no behavioural support;
- usual or standard care;
- less-intense forms of the behavioural support; or other approaches.
The authors compared all treatments with each other using a mathematical method called network meta-analysis.
What are the main results of this review?
Compared with no behavioural support it was clear that some types of behavioural support increased people's chances of quitting for six months or longer, including: counselling and giving them money for successfully stopping smoking. More people stopped smoking with these types of support whether or not they were also taking medicines to help them stop smoking.
Behavioural support by text messages probably helped more people to stop smoking than no support.
Compared with no support, tailoring behavioural support to the person, or group of people, trying to stop smoking probably slightly increased how many of them stopped smoking, as did support that focused on how to stop smoking.
Increasing the intensity of the support given, such as contacting people more often or having longer sessions, modestly increased how many people stopped smoking.
The authors are uncertain about:
- the effects of other types of behavioural support, including hypnotherapy, exercise-based support, and entering competitions; and
- the effect of who gives the behavioural support.
Only some studies reported results for unwanted effects; in these, behavioural support did not increase the numbers of any unwanted effects.
How confident are the authors in these results?
The authors are confident that counselling and rewards of money help people to stop smoking; they do not expect that more evidence will change these results. They are less confident in the results for other types of behavioural support, and about who gives the support and how. They found limitations with some of the studies, including how they were designed, conducted, and reported. These results are likely to change when more evidence becomes available. More studies are needed.
The report draws on data from the EU Trials Tracker and summarises the current extent of clinical drug trial reporting for different organisations in Sweden. Under the European Commission’s Clinical Trial Regulation, clinical trial sponsors must post summary results to the EU Clinical Trials Register within one year of a study ending, or six months for paediatric trials.
The report found that over 70% of clinical trials whose results were verifiably due had not yet posted results. This is far below the European average. However, several Swedish trial sponsors have already pledged to make improvements.
Matteo Bruschettini, Director of Cochrane Sweden, says of the report: “Cochrane Sweden, which was awarded full independent Cochrane centre status in 2020, promotes initiatives to improve the reporting of all studies. Our hope is that this report and the linked implications and recommendations can help to facilitate improved reporting of clinical trials within Sweden. We share the goal to get more complete and accurate evidence on which to make informed health decisions within healthcare, and better health for everyone.”
Cochrane supports clinical trial transparency. We rely on the availability of results from clinical trials to produce high quality and relevant systematic reviews. When trial results – whether positive, negative, or neutral – are not published, it is not possible to make truly evidence-informed decisions about healthcare, and people can be put at risk of harm.
A stillbirth is generally defined as the death of a baby before birth, at or after 24 weeks of development. It is most common in low‐ and middle‐income countries but also affects people in high‐income countries. Numbers of stillbirths have not fallen much in the last 20 years and, despite the high numbers, it is not widely recognised as a global health problem.
This overview of Cochrane systematic reviews included 43 Cochrane reviews that assessed 61 different ways of preventing stillbirth during pregnancy, or infant deaths around the time of birth. However, few of these provided any clear evidence of an effect during pregnancy to reduce the risk of stillbirth or infant death. They were grouped into four different areas: nutrition, preventing infection, managing mothers' other healthcare problems, and looking after the baby before it is born.
- Giving mothers balanced energy and protein supplements to increase the growth of the baby, particularly in undernourished pregnant women, probably reduces stillbirth by 40%.
- For Vitamin A alone versus placebo (sham) or no treatment, and multiple micronutrients with iron and folic acid compared with iron with or without folic acid, there was clear evidence of no effect.
Prevention and management of infections
- Insecticide‐treated anti‐malarial nets versus no nets may reduce loss of the baby in the womb (fetus) by 33%.
Prevention, detection and management of other healthcare problems
- Where midwives were the primary healthcare provider, particularly for low‐risk pregnant women, loss of the fetus or infant deaths fell by 16%.
- Having a trained traditional birth attendant versus having an untrained traditional birth attendant probably reduces stillbirth in rural populations of low‐ and middle‐income countries by 31% and infant death by 30%.
- A reduced number of antenatal care visits probably results in an increase in infant death around the time of birth.
- Community‐based intervention packages (including community‐support groups/women's groups, community mobilisation and home visits, or training traditional birth attendants who made home visits) may reduce stillbirth by 19%.
Checking the baby before birth
- Cardiotocography measures the baby's heart rate and contractions in the womb. It can be recorded automatically by computer or manually, with pen and paper. Computerised cardiotocography to monitor baby’s well‐being in the womb, by measuring contractions, probably reduces the rate of infant deaths around the time of birth by 80% when compared with traditional cardiotocography.
The overview was uncertain about the effects of other methods.
Further high‐quality RCTs are needed to evaluate the effects of antenatal preventive interventions and which approaches are most effective to reduce the risk of stillbirth. Stillbirth (or fetal death), perinatal and neonatal death need to be reported separately in future RCTs of antenatal interventions to allow assessment of different interventions on these rare but important outcomes and they need to clearly define the target populations of women where the intervention is most likely to be of benefit.
Dr. Erika Ota, lead author and professor at the St. Luke’s International University in Japan says, “Stillbirth can be very upsetting for families and looking at what the evidence was across Cochrane systematic reviews was important to us. Cochrane systematic reviews provide high quality evidence. We assessed 43 Cochrane reviews with over 60 different ways to prevent stillbirth and infant deaths at birth.
We found that from these 60 different interventions, most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death. However, several interventions suggested a clear benefit to preventing still birth and infant deaths at birth, such as balanced energy/protein supplements, midwife‐led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide‐treated anti‐malarial nets and community‐based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful.
The effectiveness of the methods used to prevent stillbirth varied depending on where they took place, highlighting that it is important to understand how they were tested. Unfortunately the findings cannot be applied to women in general and across all global settings but hope this overview will help show that further high-quality trials are needed in low- and middle income countries where a high burden of stillbirths occur.”